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Dear Mr. Meigs: If your syncope occurs when you are laying down flat, you need to consult your doctor as this may be cardiac in origin. Otherwise, the answer to your question is addressed in my previous post. Jorge A. Romero, MD ----- Original Message ----- From: "David Meigs" <[log in to unmask]> To: "Jorge A Romero MD" <[log in to unmask]> Sent: Sunday, September 09, 2001 7:38 PM Subject: Re: sleep attack - Syncope > Dr's Romero, Fink, & all, > > When I experience Syncope from drops in blood pressure (example - 76/38) it > may occur when walking, etc, and often when I lay down flat. It has its own > mind about when it happens. Is there a drug that works best for this type > of syncope? I currently use lots of salt & water which helps most of the > time? > > You mentioned this can be caused by PD drugs. Sinemet does not work for me > so I don't take it very often. I also take baclofen, wellbutrin, & > provocal. My syncope predates all my meds though. > > Any idea's? > > THANK YOU! > > David > > ----- Original Message ----- > From: "Jorge A Romero MD" <[log in to unmask]> > To: <[log in to unmask]> > Sent: Sunday, September 09, 2001 3:51 PM > Subject: Re: sleep attack > > > The problem you describe seems to be what is more accurately called syncope > or fainting from drops in blood pressure due to vertical position > (orthostatic hypotension). Indeed, these are not sleep attacks if they are > related to drops in blood pressure. > > Orthostatic hypotension can be caused by Parkinson's Disease, and can be > made worse by the drugs used to treat Parkinson's Disease, such as levodopa > or the dopamine agonists. More often than not it is experienced as simple > dizziness or feeling of lightheadedness and near fainting when standing. > Occasionally some PWP may actually faint, as your Dad does. It can be a > difficult problem when the dosage of antiparkinsonian medication necessary > to be effective to relieve the rigidity and immobility of Parkinson's cause > so much orthostatic hypotension that syncope or fainting does occur. > > The problem can be very serious because such blackouts can cause falls and > injuries if they occur at the wrong time. A hip fracture in a PWP can be a > very serious problem. > > First, it is important to rule out other causes, such as anemia, blood loss, > adrenal insufficiency, or the use of certain medications such as diuretics, > nitrates (for angina), or antihypertensive medications, or antidepressants, > or other conditions which may cause or contribute to the problem. > > After that is done, there may be a variety of ways to deal with this > problem, which can be used alone or in combination at times: > > 1) Adjust the dose of antiparkinsonian medication downward if possible. > 2) When standing, do so gradually, first sit, and then stand. > 3) Use support stockings to prevent pooling of blood in the legs > 4) A minearalocorticoid drug, most commonly fludrocortisone (Florinef) can > be given to promote fluid retention if possible. This may lead to edema of > the legs, or even heart failure in susceptible individuals, so it must be > done with the supervision of your neurologist or internist. > 5) Drugs that stimulate the sympathetic system can also be used, as Dr. > Fink suggested. Ephedrine is a commonly used one. > 6) The new drug, midodrine (ProAmatine) is also effective and may be > gentler than Ephedrine. Nowadays, it is more commonly used than Ephedrine. > 7) Other drugs, such as atropine (to accelerate the heartbeat) or beta > blockers (to block the effect of the autonomic nervous system in dilating > the blood vessels) have been used as well. They must be used under strict > supervision. > > Obviously this is a complicated problem that requires the attention of your > neurologist or internist, or both, working in combination. The choice of > which of these approaches is best requires careful consideration and > monitoring. > > If the problem is unusually severe, your neurologist might also want to > consider the possibility that your Dad may have one of the "Parkinson Plus" > syndromes, or "Multiple System Degeneration. The Shy Drager Syndrome is one > of these which is associated with autonomic nervous system dysfunction, > orthostatic hypotension, impotence, problems with GI motility, and also > often with spasticity and cerebellar ataxia as the disease progresses. > > I recommend that you discuss these issues carefully with your Dad's > neurologist, since he is the best equipped to guide you in his individual > and particular case. > > Jorge A. Romero, MD > > ----- Original Message ----- > From: "vmehra" <[log in to unmask]> > To: <[log in to unmask]> > Sent: Sunday, September 09, 2001 12:05 PM > Subject: sleep attack > > > This is about loss of consciosness. My Dad started fainting or having black > outs very regularly especially when the PD progressed fast. > His Blood Pressure would drop and he would almost turn blue. This usually > happened when he was sitting in one position for too long. > This is what we did knowing that being in thois state for more that 2 > minutes can be fatal. We would put his head below the level of his heart. If > he was on a chair, we would just bend the chair back till his head would be > nearer the floor. That would revive him in seconds. > This black out in his case was due to low B.P. > > Take care everyone > Lavanya > > ---------------------------------------------------------------------- > To sign-off Parkinsn send a message to: mailto:[log in to unmask] > In the body of the message put: signoff parkinsn > > ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn